PUD

Question 1

PUD Etiology

Answer 1

1. H pylori infection
2. NSAID use
3. Stress (mucosal damage/bleeding)

Question 2

Non-pharm Considerations

Answer 2

-Avoid tobacco/smoking
-Diet (trigger foods, don’t lie down 2-3 hrs after eating, limit alc/caffeine)
-Weight loss
-Elevate head of the bed 6-8 in or GERD pillow use

Question 3

H. Pylori: 1st Line Tx

Answer 3

1. Quad: PPI + Bismuth + Tetracycline + Metronidazole (PMTB)
2. PPI + Clari + Amox + Metronidazole
3. Clari + Amox + PPI
4. Clar + Metro + PPI
5. Levo + Amox + PPI (salvage tx)

*If PCN allergy = don’t use any with Amox

Question 4

Pt previously taken any macrolide (ACE) or Clarithromycin resistance is >15%?

Answer 4

DONT use any tx with Clarithromycin

Question 5

Quad Tx Dosing

Answer 5

Bismuth QID

Metro QID

Tetra QID

PPI QD-BID

Question 6

Clari w/ Metro Dosing

Answer 6

Metro TID

Clari BID

PPI QD-BID

Question 7

Least involvement of CYP2C19 for PPIs

Answer 7

Rabeprazole

-Clari is strong CYP3A inhibitor

Question 8

Quad Tx: AEs

Answer 8

Bismuth: darkened stool, color changes

Tetra: photosens

Metro: DSR, tast disturbance

Question 9

Salvage Tx

Answer 9

Avoid abx used in 1st option tried

= Levo triple w/ PPI w/ Amox

If first option tried had Clari
= Bismuth QUAD
or above

Question 10

Recommendation for true PCN allergy and etoH abuse?

Answer 10

LOAD (levofloxacin + omeprazole + nitazoxanide [AliniaTM) + doxycycline) ??? (usually for 1st line)